Dr. Natalie Leland is an occupational therapy researcher whose goal is to become an independent investigator in rehabilitation health services research, focusing on developing stakeholder-driven evidence-based quality measures, facilitating provider performance improvement, and enhancing patient-centered outcomes. The proposed award will facilitate this goal by expanding her competencies in stakeholder engagement, quality measure development, use of electronic health records, and healthcare policy. Dr. Leland will capitalize on the wealth of assets available at the University o Southern California, including nationally recognized NIH-funded mentors in gerontology, health policy, and economics. The goal of Dr. Leland's proposed K01 research is to develop patient-centered evidence-based quality measures of rehabilitation services in the area fall prevention. Such information is expected to minimize fall rates by defining gaps in rehabilitation documentation (and presumably rehabilitation practice) and thus informing opportunities for improving the quality of rehabilitation services. Despite preventative interventions that have the potential to decrease fall risk, post-acute care patients continue to fall, resulting in poor outcomes (e.g., rehospitalization) and unnecessary healthcare costs. As a result, there is serious concern about the extent to which evidence-based treatments are provided in rehabilitation settings. The most effective strategy for improving fall rates is to ensure the delivery and subsequent documentation of fall prevention interventions that are associated with high quality care. Primary care physicians have successfully implemented a protocol for the development of fall prevention quality measures, which begins by defining minimum standards for care, and has resulted in improved physician performance, and better patient outcomes. Thus, the first step towards improving outcomes for hip fracture patients in rehabilitation is to define the minimum standards of care so deficiencies in rehabilitation care can be identified and subsequently ameliorated. To ensure the development of stakeholder-driven quality measures, Dr. Leland will integrate qualitative and quantitative approaches to define high quality hip fracture rehabilitation for fall prevention. These findings will be used as preliminary data in a later R01 proposal using electronic health records from a nationally representative sample of rehabilitation providers in a longitudinal comparative effectiveness study. That study will evaluate the extent to which receipt of prioritized fall prevention care for hip fracture patients results in improved patient-centered outcomes. Defining the minimum standards of care for rehabilitation settings is a critical first step in facilitating high quality rehabilitation that dcreases falls. The current study is directly responsive to AHRQ's mission of improving the quality, safety, efficiency, and efficacy of health care for all Americans. Further, in drawing on the diversity of the older adult rehabilitation population in urban Los Angeles, multiple AHRQ priority populations will be included such as minorities, individuals with disabilities or multiple chronic conditions, and women.
Currently, there are no measures to inform stakeholders about the quality of post-acute care rehabilitation. Identifying patient-centered and evidence-based fall prevention processes in hip fracture rehabilitation and evaluating the feasibility to capture them in clinical documentation is an initial step towards defining high quality rehabilitation. The results of this study will offer rehabilitation researchers with a framework to define quality of care in other rehabilitation populations and provide consumers, providers, and administrators with key preliminary evidence of gaps in rehabilitation practice and documentation thus opportunities for improving the quality of rehabilitation care for older adults with a hip fracture.
| Leland, Natalie E; Lepore, Michael; Wong, Carin et al. (2018) Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners. Disabil Rehabil 40:646-654 |
| Halle, Ashley D; Mroz, Tracy M; Fogelberg, Donald J et al. (2018) Occupational Therapy and Primary Care: Updates and Trends. Am J Occup Ther 72:7203090010p1-7203090010p6 |
| Elliott, Sharon; Leland, Natalie E (2018) Occupational Therapy Fall Prevention Interventions for Community-Dwelling Older Adults: A Systematic Review. Am J Occup Ther 72:7204190040p1-7204190040p11 |
| Wong, Carin; Fagan, Brenda; Leland, Natalie E (2018) Occupational Therapy Practitioners' Perspectives on Occupation-Based Interventions for Clients With Hip Fracture. Am J Occup Ther 72:7204205050p1-7204205050p7 |
| Wong, Carin; Leland, Natalie E (2018) Clinicians' Perspectives of Patient Engagement in Post-Acute Care: A Social Ecological Approach. Phys Occup Ther Geriatr 36:29-42 |
| Fogelberg, Donald J; Leland, Natalie E; Blanchard, Jeanine et al. (2017) Qualitative Experience of Sleep in Individuals With Spinal Cord Injury. OTJR (Thorofare N J) 37:89-97 |
| Leland, Natalie E; Fogelberg, Donald J; Halle, Ashley D et al. (2017) Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform. Am J Occup Ther 71:7101090010p1-7101090010p6 |
| Welsh, Rodney Laine; Graham, James E; Karmarkar, Amol M et al. (2017) Effects of Postacute Settings on Readmission Rates and Reasons for Readmission Following Total Knee Arthroplasty. J Am Med Dir Assoc 18:367.e1-367.e10 |
| Leland, Natalie E; Fogelberg, Donald; Sleight, Alix et al. (2016) Napping and Nighttime Sleep: Findings From an Occupation-Based Intervention. Am J Occup Ther 70:7004270010p1-7 |
| Kim, Lauren H; Leland, Natalie E (2016) Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care. Phys Occup Ther Geriatr 34:155-168 |
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